pn 2011 nclex tips

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NCLEX-PN TIPS

Targeted Instruction and Passing Strategies

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NCLEX-PN TIPS 1

Editor

Virtual and Distant Education Teams

Associate Editor

Brant Stacy, BS Journalism, BA EnglishProduct Developer

Copyright Notice

All rights reserved. Printed in the United States of America. No part of this book shall be reproduced, stored ina retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise,without written permission from the publisher. All of the content you see in this publication, including, forexample, the cover, all of the page headers, images, illustrations, graphics, and text, are subject to trademark,service mark, trade dress, copyright and/or other intellectual property rights or licenses held by AssessmentTechnologies Institute, LLC, one of its affiliates, or by third parties who have licensed their materials toAssessment Technologies Institute, LLC. The entire content of this publication is copyrighted as a collectivework under U.S. copyright laws, and Assessment Technologies Institute, LLC owns a copyright in the selection,coordination, arrangement and enhancement of the content. Copyright Assessment Technologies Institute, LLC,2011. NCLEX-PNis a registered trademark of the National Council of State Boards of Nursing, Inc. and, as such,use of the trademark is not considered an endorsement of this book.

NCLEX-PNTIPS

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Table of Contents

Unit 1 NCLEX-PN Overview

Test Strategies and Essentials ......................................................................................................................3

Unit 2 2011 NCLEX-PN Detailed Test Plan

Safe and Effective Care Environment .........................................................................................................5

Health Promotion and Maintenance .........................................................................................................6

Psychosocial Integrity ................................................................................................................................7

Physiological Integrity ...............................................................................................................................7

Unit 3 Understanding the NCLEX-PN Test Plan

Types of Exam Items ................................................................................................................................10

Common Pitfalls and Relevant Information .............................................................................................11

Summary ..................................................................................................................................................14

Unit 4 Application of Knowledge

Staying Focused ........................................................................................................................................15

Managing Test Items ................................................................................................................................15

Strategies ..................................................................................................................................................15

Essential NCLEX-PN Knowledge ...............................................................................................................17

Unit 5 Mastering Difficult Questions

Examine Question Layers .........................................................................................................................19

Airway, Breathing, and Circulation (ABC) ................................................................................................20

Safe and Effective Delegation ...................................................................................................................21

Conclusion

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NCLEX-PN TIPS 3

Overview

Now that youve graduated and worked hard preparing for a career in nursing, the time has come to take theNCLEX-PN. You may be asking yourself:

Ive prepared for so long, now what?

Am I really ready to take the test?

How can I be assured of a strong finish in this final stretch?

Youve learned the bulk of your knowledge in your nursing program, and your instructors have given you a lot ofuseful information. Now, the National Council Licensure Exam (NCLEX-PN) will ask you to demonstrate how wellyou understand that knowledge and how well you can apply it to situations you may encounter in your nursingcareer. This document will offer several strategies that you can use to increase your chances of passing theNCLEX-PN.

Test Strategies and Essentials

To become a licensed nurse in the United States or its territories, you must pass the NCLEX-PN exam. Preparationfor the NCLEX-PN should include familiarizing yourself with the construction and administration of the exam.

The National Council of State Boards of Nursing (NCSBN) prepares the NCLEX-PN exam. The exam is the sameregardless of the state or territory where you test. However, the requirement for receiving authorization to test doesvary from state to state. To find specific requirements for your state or territory, go to www.ncsbn.organd clickon the Boards of Nursing tab. To find testing centers in your state, go to www.pearsonvue.com/NCLEX. Somestates have compacts that allow mobility of their licensure status, which means if you are licensed to practice withina particular state, other states may offer reciprocity that allows you to practice in those states as well. You can findinformation about state compacts on the NCSBN website www.ncsbn.org/nlc.htm.

You may wonder why you have to take the NCLEX-PN licensure exam. The NCSBN wants to ensure that oursociety has safe and effective nursing care. The licensure exam is a means of providing professional regulation forcompetence at the entry level and helps to ensure public safety.

It is important to understand that the NCLEX-PN is not a test of intelligence. It is not a test for nurses who havepractice experience to show their level of achievement. It does not ask questions about highly specialized nursingpractices, cutting-edge technologies, vendor-specific equipment, or medication therapies not approved by the U.S.Food and Drug Administration. The NCSBN uses specific criteria to ensure fairness, thus the exam must be:

Psychometrically sound.

Legally defensible.

Objective.

Empirical.

Reliable.

To identify the current nature of entry-level professional practice, NCSBN conducts a practice analysis study every3 years. Using the data, the NCSBN determines the competency level that nurses need to deliver safe and effectivecare. The questions youll encounter on the NCLEX-PN are consistent with what entry-level nurses actually do inclinical practice.

UNIT 1 NCLEX-PN OVERVIEW

Sections Test Strategies and Essentials

NCLEX-PNOverview

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NCLEX-PN TIPS 4

NCLEX-PN OVERVIEW

The NCLEX-PN exam uses a computer-adaptive testing approach. This means the computer will determinethe level of difficulty for questions based on how you answered previous ones. So remember, every examwill be different. But, every test-taker begins with relatively easy questions. Each time you answer a question,the computer technology estimates your ability within the client-need categories. With every answer, thecomputers estimate of your knowledge level gets more precise. If all goes well, youll reach a certain point inthe testing process where you demonstrate a minimal competency. This occurs when you answer questionsof a certain difficulty, and not after you answer a certain percentage of items. At this point, the computercompares your ability level with the national passing mark. One of three outcomes will occur.

If you are above the passing standard at question 85, your exam will end and you will pass.

If you are below the passing standard at question 85, your exam will end and you will fail. If your ability estimate is close to the passing mark, either nearly below or nearly above, then you will

continue to receive more questions until a more precise judgment can be made about your knowledgeof the content on the exam. You will either pass or fail depending on your performance to that point.You wont pass if you score at the passing mark. You will need to achieve above it to receive a nursinglicense.

Below are other important facts about the NCLEX-PN exam.

The exam includes a minimum of 85 questions and a maximum of 205.

The maximum time allowed is 5 hr.

There is an optional 10-min break after the first 2 hr. There is a second optional 10-min break after 3.5hr.

Every test-taker receives 25 experimental questions. You will not be able to identify which items are experimental.

Answers to experimental questions do not count in your score.

The full 205-question set is never randomly administered. The test will end when you demonstrate aminimal competency (anywhere from 85 to 205 questions).

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NCLEX-PN TIPS 5

Overview

On April 1, 2011, the NCSBN implemented a new test plan and a revised passing standard. To help determinethe passing standard, the NCSBN conducted a practice analysis study to determine the minimum amount ofknowledge, skills, and ability required for safe and effective entry-level nursing.

The distribution of test items in the NCLEX-PN Detailed Test Plan reflects the emphasis areas from the practiceanalysis study. Below are the activity statements from the 2009 PN Practice Analysis of Newly Licensed PNs inthe United States and Member Board Jurisdictions, which are in the 2011 NCLEX-PN test plan. Each client-needcategory and subcategory lists topic areas, while the percentages demonstrate the distribution for each categorywithin the test as a whole. As you prepare for the NCLEX-PN, familiarize yourself with the emphasis areas in the

current test plan. Also, note the difference between the previous plan (published in 2008). This will help you focusyour study efforts.

SAFE AND EFFECTIVE CARE ENVIRONMENT

Management of Care (13% to 19%)

Definition: The LPN/VN collaborates with the health care team members to facilitate effective client care.

Topic areas related topicsinclude, butnot limited to:

Provide information about advance directives.

Advocate for client rights and needs.

Promote client self-advocacy.

Assign client care and/or related tasks (assistive personnel or LPN/VN).

Involve client in decision making.

Contribute to the development and/or update of the client plan of care.

Participate as a member of an interdisciplinary team.

Recognize and report staff conflict.

Participate in staff education.

Use data from various sources in making clinical decisions.

Supervise/evaluate activities of assistive personnel.

Maintain client confidentiality.

Provide for privacy needs.

Follow up with client after discharge.

Participate in client discharge or transfer.

Provide and receive report.

Organize and prioritize care for assigned group of clients.

Participate in client consent process.

Use information technology in client care. Receive and process health care provider orders.

Recognize task/assignment you are not prepared to perform and seek assistance.

Respond to the unsafe practice of a health care provider (intervene or report).

Follow regulation/policy for reporting specific issues (abuse, neglect, gunshot wound, or communicabledisease).

Participate in quality improvement (QI) activity (collecting data or serving on QI committee).

Apply evidence-based practice when providing care.

Participate in client data collection and referral.

Participate in providing cost-effective care.

Integrate advance directives into the clients plan of care.

UNIT 2 2011 NCLEX-PNDETAILED TEST PLAN

Sections Safe and Effective Care Environment

Health Promotion and Maintenance Psychosocial Integrity

Physiological Integrity

2011 NCLEX-PNDetailed Test Plan

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NCLEX-PN TIPS 6

2011 NCLEX-PN DETAILED TEST PLAN

SAFE AND EFFECTIVE CARE ENVIRONMENT

Safety and Infection Control (11% to 17%)

Definition: The LPN/VN contributes to the protection of clients and health care personnel from health and environmentalhazards.

Topic areas

related

topics include,

but not

limited to:

Identify client allergies and intervene as appropriate.

Verify the identity of a client.

Assist in or reinforce education to client about safety precautions.

Evaluate the appropriateness of health care provider order for client.

Participate in preparation for internal and external disasters (fire, natural disaster). Use safe client handling (body mechanics).

Identify and address hazardous conditions in health care environment (chemical, smoking, or biohazard).

Acknowledge and document practice error (incident report).

Follow protocol for timed client monitoring (restraint, safety checks).

Implement least restrictive restraints or seclusion.

Assure availability and safe functioning of client-care equipment.

Initiate and participate in security alert (infant abduction, flight risk).

Identify the need for and implement appropriate isolation techniques.

Use standard/universal precautions.

Use aseptic and sterile techniques.

HEALTH PROMOTION AND MAINTENANCE

Definition: The LPN/VN provides nursing care for clients that incorporates knowledge of expected stages of growth anddevelopment and prevention and/or early detection of health problems.

Topic areas

related

topics include,

but not

limited to:

Provide care that meets the special needs of the newborn: less than 1 month old.

Provide care that meets the special needs of infants or children 1 month to 12 years.

Provide care that meets the special needs of adolescents 13 to 18 years.

Provide care that meets the special needs of young adults 19 to 30 years.

Provide care that meets the special needs of adults 31 to 64 years.

Provide care that meets the special needs of adults 65 to 85 years.

Provide care that meets the special needs of adults greater than 85 years.

Assist with fetal heart monitoring for the antepartum client.

Assist with monitoring a client in labor.

Monitor recovery of stable postpartum client.

Collect data for health history.

Collect baseline physical data (skin integrity, height and weight).

Recognize barriers to communication or learning.

Compare client development to norms.

Assist client with expected life transition (attachment to newborn, parenting, retirement).

Provide care and resources for beginning-of-life and/or end-of-life issues and choices.

Identify and educate clients in need of immunizations (required and voluntary).

Participate in health screening or promotion programs.

(7% TO 13%)

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NCLEX-PN TIPS 7


PSYCHOSOCIAL INTEGRITY

Definition: The LPN/VN provides care that assists with promotion and support of the emotional, mental, and social well-being of clients.

Topic areas

related

topics include,

but not

limited to:

Assist in or reinforce education to caregivers/family on ways to manage client with behavioral disorders.

Participate in behavior management program by recognizing environmental stressors and/or providing atherapeutic environment.

Participate in reminiscence or validation therapy, or reality orientation.

Participate in client-group session.

Identify signs and symptoms of substance abuse/chemical dependency, withdrawal, or toxicity.

Collect data regarding client psychosocial functioning.

Identify client use of effective and ineffective coping mechanisms.

Identify significant body or lifestyle changes and other stressors that may affect recovery/health maintenance.

Assist client to cope/adapt to stressful events and changes in health status (end of life, grief and loss, lifechanges, or physical changes).

Collect data on client who has potential to be violent.

Assist in managing the care of the client who is angry/agitated.

Make adjustment to care with consideration of a clients spiritual or cultural beliefs.

Explore why client is refusing or not following treatment plan.

Assist in the care of the client who is cognitively impaired.

Promote positive self-esteem of client.

Provide emotional support to client and family.

PHYSIOLOGICAL INTEGRITY

Basic Care and Comfort (9% to 15%)

Definition: The LPN/VN provides comfort to clients, and assists them in the performance of their activities of daily living.

Topic areas

related

topics include,

but not

limited to:

Use transfer assistive devices (t-belt, slide board, mechanical lift).

Institute bowel or bladder management.

Discontinue or remove peripheral IV line, NG tube, or urinary catheter.

Perform an irrigation of urinary catheter, bladder, wound, ear, nose, or eye.

Provide for mobility needs (ambulation, range of motion, transfer to chair, repositioning, the use of adaptiveequipment).

Use measures to maintain or improve client skin integrity.

Provide care to client in traction.

Apply or remove immobilizing equipment (a splint or brace). Assist in the care and comfort for a client with a visual and/or hearing impairment.

Use alternative/complementary therapy (acupressure, music therapy, herbal therapy) in providing client care.

Provide nonpharmacological measures for pain relief (imagery, massage, repositioning).

Evaluate pain using a rating scale.

Provide feeding and/or care for client with enteral tubes.

Monitor and provide for nutritional needs of client (laboratory findings, calorie counts/percentages, dailyweight).

Monitor client I&O.

Assist with activities of daily living.

Assist in providing postmortem care.

Provide measures to promote sleep/rest.

(7% TO 13%)

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NCLEX-PN TIPS 8



Pharmacological and Parenteral Therapies (11% to 17%)

Definition: The LPN/VN provides care related to the administration of medications and monitors clients receivingparenteral therapies.

Topic Areas

related

topics include,

but not

limited to:

Perform calculations for medication administration.

Reinforce education to client regarding medications.

Evaluate client response to medication.

Follow the rights of medication administration.

Maintain medication safety practices (storage, checking for expiration dates, compatibility). Reconcile and maintain medication list or medication administration record.

Administer medication by oral route.

Administer IV piggyback (secondary) medications.

Administer medication by gastrointestinal tube (g-tube, NG tube, g-button, or j-tube).

Administer a subcutaneous, intradermal or intramuscular medication.

Administer medication by ear, eye, nose, rectum, vagina, or skin.

Count narcotics/controlled substances.

Regulate client IV rate.

Monitor transfusion of blood product.

Monitor and maintain client IV site and flow rate.

Risk Potential (9% to 15%)

Definition: The LPN/VN reduces the potential for clients to develop complications or health problems related totreatments, procedures, or existing conditions.

Topic Areas

related

topics include,

but not

limited to:

Check and monitor client vital signs.

Perform an electrocardiogram (ECG).

Perform venipuncture for blood draws.

Collect specimen (urine, stool, gastric contents, or sputum for diagnostic testing).

Monitor diagnostic or laboratory test results.

Identify signs or symptoms of potential prenatal complication.

Perform neurological checks.

Perform circulatory checks.

Check for urinary retention (bladder scan, palpation).

Administer and check proper use of compression stockings/sequential compression devices.

Perform risk monitoring and provide follow up.

Monitor continuous or intermittent suction of NG tube.

Implement measures to prevent complication of client condition or procedure (circulatory complication,seizure, aspiration, or potential neurological disorder).

Evaluate client respiratory status by measuring oxygen (O2) saturation.

Provide care for client before surgical procedure including teaching.

Insert urinary catheter.

Insert NG tube.

Assist with the performance of a diagnostic or invasive procedure.

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NCLEX-PN TIPS 9



Physiological Adaptation (9% to 15%)

Definition: The LPN/VN participates in providing care for clients with acute, chronic, or life-threatening physical healthconditions.

Topic areas

related

topics include,

but not

limited to:

Assist with invasive procedures (central-line placement).

Implement and monitor phototherapy.

Maintain the desired temperature of a client (cooling and/or warming blanket).

Monitor and care for clients who are receiving ventilation.

Monitor and maintain devices and equipment for drainage (surgical wound drains, chest-tube suction, negativepressure, wound therapy).

Perform and manage care of a client who is receiving peritoneal dialysis.

Perform suctioning (oral, nasopharyngeal, endotracheal, tracheal).

Provide wound care and/or assist with dressing change.

Provide ostomy care and education (tracheal, enteral).

Provide pulmonary hygiene (chest physiotherapy, incentive spirometry).

Provide postoperative care.

Manage the care of the client who has fluid and electrolyte imbalance.

Monitor and maintain arterial lines.

Manage the care of a client who has a pacing device (pacemaker, biventricular pacemaker, implantablecardioverter defibrillator).

Manage the care of the client who is on telemetry. Manage the care of a client who is receiving hemodialysis.

Manage the care of a client who has alteration in hemodynamics, tissue perfusion, and hemostasis (cerebral,cardiac, peripheral).

Manage the care of a client who has impaired ventilation/oxygenation.

Evaluate the effectiveness of the treatment regimen for a client who has an acute or chronic diagnosis.

Perform emergency care procedures (CPR, abdominal thrust maneuver, respiratory support, automatedexternal defibrillator).

Identify pathophysiology related to an acute or chronic condition (signs and symptoms).

When providing client care, recognize signs and symptoms of complications and intervene appropriately.

Application and analysis items primarily compose the NCLEX-PN. However, there are some lower-level knowledgeand comprehension items. Be sure you have a broad knowledge in all client-need categories. This will help youdemonstrate a minimal level of competency when you need to apply your knowledge to the scenarios on the exam.

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NCLEX-PN TIPS 10

OverviewYou will learn how to determine what information needs addressing by eliminating information that is irrelevant.This process clears a pathway to the correct answer. It also helps you answer quite a few of the most difficultquestions correctly, which will lead to a passing score on the exam.

Types of Exam Items

The NCLEX-PN examination is a different type of testing experience than taking a unit exam in nursing school.All test items follow Blooms Taxonomy (Bloom, et al, 1956), which is the progressive hierarchy for classifying apersons thinking skills. Most items are at the application and analysis levels of the taxonomy. The highest twolevels are synthesis and evaluation, which are present, but less common with standard four-option multiple-choicequestions.

Even though you wont see many knowledge or comprehension questions on the NCLEX-PN, you should be ableto identify them as you prepare for your exam. Then, you wont spend too much of your study time on thesequestions. And, there wont be any surprises on test day.

Knowledge questions test recall and recognition. Consider the examples below (correct answers are in bold).

A client has an enteral feeding tube inserted for nutritional supplementation. Before administering the first bolus feeding, howshould the nurse verify proper placement of the tube?

A. Check for residual gastric contents.

B. Obtain an x-ray to confirm tube placement.

C. Inject air into the tube while listening over the epigastrium.

D. Confirm that the pH of the gastric aspirate is less than 4.0.

Comprehension questions test the ability to translate and interpret.

Prior to administering morning medications to a client, a nurse notes the activated partial thromboplastin time (aPTT) is 110seconds. Which of the following actions should the nurse take first?

A. Hold the scheduled dose of heparin.

B. Administer the medications, as prescribed.

C. Compare the finding to the previous aPTT level.

D. Ask the laboratory to repeat the test for verification.

Remember, you will see a lot of application and analysis level questions on the NCLEX-PN. These questions requireyou to use your knowledge to solve client problems. You need to decide what is most important in the context ofmultiple client conditions. Before attempting to choose an answer, you should consciously identify key words inthe stem that are relevant and dismiss irrelevant information.

UNIT 3 UNDERSTANDING THE NCLEX-PNTEST PLAN

Sections Types of Exam Items, Common Pitfalls and Relevant Information, Summary

Understanding the NCLEX-PNTest Plan

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NCLEX-PN TIPS 11

UNDERSTANDING THE NCLEX-PN TEST PLAN

Common Pitfalls and Relevant Information

Graduate nurses commonly choose answers that relate to what is being asked rather than answer what is beingasked.

A nurse is standing at the bedside of a client when the monitor pattern changes and appears to show ventricular fibrillation.Which of the following actions should the nurse take first?

A. Defibrillate the client.

B. Start rescue breathing.

C. Print a copy of the rhythm.

D. Palpate the clients carotid pulse.

The question assumes that youre knowledgeable about ventricular fibrillation, which is always a pulseless rhythm.You should also know that you treat ventricular fibrillation by performing defibrillation.

What is the question asking?

What is the treatment for ventricular fibrillation? No!

What is the priority nursing action when you suspect ventricular fibrillation? Yes!

The word appears changes what the question is asking. You should recognize that although the monitorshows ventricular fibrillation, you shouldnt initiate a rescue intervention until you establish absence of apulse. Therefore, D is the correct option.

Although you may have the knowledge to answer the question correctly, you must also be careful to

choose the correct order of interventions. You can accomplish this by giving key words in the stemappropriate attention. If you dont do this, you may choose an answer to a question that was not asked.

What information is relevant?

Examine the examples below and practice identifying issues that are important or irrelevant to what is beingasked.

A nurse is caring for a client who is obese and has a history of type 1 diabetes mellitus. The client is also 1 week postoperativefollowing a ventral hernia repair. He reports severe abdominal pain 1 hr after vomiting. Which of the following actions shouldthe nurse take?

A. Perform a fingerstick blood glucose test.

B. Ask the RN to administer IV pain medication.

C. Remove the dressing and observe the incision line.

D. Reinforce information on pillow splinting and repositioning.

What factor(s) are relevant in the question?

Client is obese

Client underwent abdominal surgery 1 week ago

Client is experiencing severe abdominal pain

Client vomited 1 hr ago

What factor(s) should be dismissed?

The client has a history of type 1 diabetes mellitus

The client has a ventral hernia repair


The question is asking for the priority nursing action for a client who has had abdominal surgery and vomited1 hr ago. Option C is correct because the nurse should assess the incision for wound dehiscence.

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NCLEX-PN TIPS 13


A nurse is preparing to discharge an adolescent who is primapara 12 hr after vaginal delivery of a term newborn. A follow-uphome visit is scheduled for 24 hr after discharge. Which of the following is most important for the nurse to include in the clientsdischarge teaching?

A. Demonstrate postpartum self-care skills.

B. Discuss psychological responses to childbirth.

C. Review physiological changes after childbirth.

D. Explain nutritional approaches for weight loss.


Client is primipara

Client is discharged after 12 hr

Clients first home visit is in 24 hr


Newborn born at term

Client is an adolescent


The question is asking for the most important content to teach prior to discharging a client who is primipara.So, option A is correct. Since a home visit is scheduled in 24 hr, the nurses priority needs to be education thatpromotes comfort, rest, and prevention of complications.

A client diagnosed with depression related to marital conflict asks the nurse, Do you think I should divorce my spouse or justseparate? Which of the following responses by the nurse is most appropriate?

A. What do you think is the best thing for you to do at this point?

B. If you do divorce, do you have sufficient income to support yourself?

C. How do you think divorce will affect your children now and in the future?

D. You should divorce, since marital conflict is the source of your depression.


Client is depressed


The topic of the clients decision


The question is asking for a therapeutic response to a client with depression. Option A is correct, because astatement that is open-ended and information-seeking is most appropriate.

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NCLEX-PN TIPS 14


A school nurse observes several children playing on the playground at a local elementary school. Which of the following childrenrequires immediate intervention by the nurse?

A. A child climbing on the swing-set

B. Two children arguing with each other

C. A child breathing heavily after running

D. A child squatting after playing catch with a ball


Children are school age Children are playing


The location of the school

Where the children are playing


The question is asking to identify the child that is demonstrating postplay behavior that may indicate distressor injury. Option D is correct because a squatting stance after activity is a clinical manifestation of cyanoticheart disease.

Summary

Now you should understand Blooms taxonomy and practice questions written at the application and analysis level.As you move toward succeeding on the NCLEX-PN, answering what is being asked is the starting point to gettingthe questions right. Eliminating irrelevant information will help you identify the issues of importance, which willguide you to the correct answer. Practice this strategy while taking each of the ATI practice assessments. Read eachquestion carefully and purposely dismiss irrelevant content in the stem. Draw your attention to the relevant detailsas you consider and eliminate possible answer choices.

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NCLEX-PN TIPS 15

Overview

Now that you know how to determine what the question is asking, you should turn your energy toward usingwhat you know. The following strategies will teach you to choose answers wisely, even if you are doubtful aboutyour knowledge of the topic. They will help you to stay in control of the test, minimize guessing, and reduceanxiety.

Staying Focused

Graduate nurses taking the NCLEX tend to focus on what they dont know, rather than what they do know. Theramifications of this mental approach can be devastating.

When you focus on your lack of knowledge about a particular topic, you may become anxious and start guessingor changing answers. There is also a carryover effect that can reduce your ability to answer subsequent items. You

might start losing confidence. When that happens, the test begins controlling you. You need to pause, take a deepbreath, try to relax, and move on. Remember, keep your focus.

One of the most important factors in achieving success on the NCLEX is maintaining control of the test. This comesfrom understanding the construction of the test and its administration, as well as systematically managing itsitems.

Managing Test Items

How should you manage an item when you dont think you know anything about the topic? Its natural to becomeanxious if you dont remember much about the topic; however, dont panic. Use your default testing strategy.Default strategies promote using what you know. This puts you back in the drivers seat and keeps you in controlof the test. The next section describes three important strategies.

Strategies Use time to your advantage.

Early vs. late. What do you know about questions asking you to identify early and late signs and symptoms?You should know they all have something in common. Early clinical manifestations are general andnonspecific, whereas late signs are specific and serious. Eliminate incorrect answer choices using this strategy.

Pre, post, and intra. The test may ask you questions about complications that are pertinent to certainprocedures. What should you do if you know little or nothing about the procedure? Pay attention to whetherthe question is asking about preprocedural, intraprocedural, or postprocedural concerns. Eliminate theoptions that do not correspond to what the question is asking. The correct answer may be quite obvious whenviewing the question from this perspective.

Time elapsed. The priority nursing action will change depending on the time interval stipulated. Obviously, thecloser the client is to the origination of risk, the higher the risk for complications. Sometimes, the time issue

is in terms of hours or days. In other instances, the physical location of the client will tell you how long it hasbeen since the origination of risk. Watch closely for whether the client is in the recovery room, postsurgicalunit, or somewhere else. The time issue in those words will help you eliminate incorrect answers that dontmatch what the question is asking.

Let Maslows hierarchy of needs be your guide.

When taking the NCLEX, keep in mind that physiological safety will always be more important than anythingpsychological. You can eliminate answers on the premise that you must establish physiologic safety priorto initiating therapeutic psychologic nursing actions. If you lack knowledge about what do to in a certainsituation, let Maslows hierarchy guide you toward the correct answer. Remember, the hierarchy starts withphysiological needs and proceeds to safety and security, then love and belonging, self-esteem and, finally, self-actualization.

UNIT 4 APPLICATION OF KNOWLEDGE

Sections Staying Focused, Managing Test Items, Strategies, Essential NCLEX-PN Knowledge

Application of Knowledge

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NCLEX-PN TIPS 16

APPLICATION OF KNOWLEDGE

Remember: most complete = least room for error

Youll encounter items on the NCLEX that will ask you to choose the instruction or documentation that is mostaccurate. What should you do if you dont remember much about the subject matter? Choosing an answer thatis most complete will typically result in the least room for error and subsequent delivery of safe and effectivecare. To help you determine which answer is most complete, evaluate answers on how much objectivity (fact)vs. subjectivity (opinion) there is in the answer choices. A specific value, like a blood pressure, is factual,whereas a clients report of past incidences of high blood pressure is subjective. Responses that are subjectiveare generally not correct.

Additional default strategies

You can usually discover the answer to a question by looking closely at the groupings of words or actions. Scanthe stem and the answer choices for cues. Identifying these cues often leads to a correlation that connects thestem to a particular answer choice.

Read the question and options closely for words asking about direction or magnitude. For instance, stop andconcentrate on the terms intra vs. inter; hyper vs. hypo; increase vs. decrease; lesser vs. greater; and gain vs.lose. It is common to misread these terms by simply skimming over them.

When in doubt, always choose a nursing action that could prevent harm to the client. Even if you dont knowwhether it relates to the stem, it is still a life-saving maneuver that, in all likelihood, is correct.

Rarely will a correct answer have the nurse physically leave the client. Choose an answer that keeps the nursewith the client.

In some instances, rule out an option if you know it is associated with something else. For example, you maynot know about the laboratory values for warfarin therapy, but you do know the laboratory values for heparin

and aspirin. You can eliminate those values because you are using what you know. Graduate nurses taking the NCLEX have a tendency to use the same communication skills regardless of

whether the client has anxiety, depression, schizophrenia, bipolar disorder or obsessive-compulsive disorder.Everyone wants to be caring and use empathetic listening. Unfortunately, these are not therapeutic responsesfor all disorders and every situation. Keep it very simple and apply it correctly. Again, use what you know.

Responses that are open-ended acknowledge the clients feelings and seek more information. This approach isappropriate for a client who has anxiety, a knowledge deficit, or depression.

Reality orientation is important for a client with paranoia and delusions.

Distraction is more appropriate for a client with obsessive-compulsive disorder.

Use of the nursing process can be helpful. Always remember to assess first. Even if your knowledge of thetopic is gray, you can still recognize that an answer choice is an assessment rather than an intervention.

A nurse is caring for a client who is receiving isocarboxazid (Marplan). Which of the following prescriptions should the nursequestion?

A. Ibuprofen (Motrin)

B. Nifedipine (Procardia)

C. Acetaminophen (Tylenol)

D. Acetylsalicylic acid (Aspirin)

Default strategy: If you do not know much about isocarboxazid, choose the option that is most different from theothers. Acetaminophen is a medication associated with the development of antiplatelet antibodies, resulting inthrombocytopenia. Aspirin and ibuprofen have NSAID properties that have antiplatelet aggregation properties. As thesethree are somewhat similar, the correct answer is likely to be nifedipine.

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NCLEX-PN TIPS 17


A nurse is caring for an infant who is experiencing sickle-cell crisis and requires pain medication. Which of the followingmedications should the nurse expect the infant to receive?

A. Acetylsalicylic acid (Aspirin)

B. Morphine sulfate (Morphine)

C. Meperidine hydrochloride (Demerol)

D. Acetaminophen with codeine (Tylenol #3)

Default strategy: If you do not know much about pain medication for infants, use what you do know. You probablyknow that an infant cant have aspirin-based and combination products because of the risk of Reye syndrome; therefore,

acetylsalicylic acid is incorrect. You can safely administer acetaminophen to children, and acetaminophen with codeinealso addresses severe pain. Meperidine hydrochloride causes metabolites to form in the CNS. And for an infant, morphineis a powerful medication that may possibly be given after the acetaminophen with codeine. The best answer for thisquestion is D.

A nurse is caring for a client who has received 3 months of 5-fluorouracil (5-FU) therapy for the treatment of breast cancer. Whichof these findings should the nurse anticipate as an expected response to therapy? (Select all that apply.)

A. WBC count of 1,200 mm3

B. Weight gain of 2.27 kg (5 lb)

C. Blood pressure of 190/102 mm Hg

D. Urine-specific gravity of 1.043

E. Platelets of 5,000 mm3

Default strategy: Since this medication is a chemotherapy agent (which is immunosuppressive therapy), look for signs ofimmunosuppression. This should lead you to the correct answer, which is A and E.

A client dies while her partner is standing at the bedside. What should the nurse do?

A. Give the partner time alone with the client.

B. Stay with the partner at the clients bedside.

C. Ask the chaplain to come be with the partner.

D. Escort the partner to a private conference room.

Default strategy: Test-takers usually miss these common items. Graduate nurses think families want to be left alone togrieve. Remember, the default strategy: Rarely will a correct answer have a nurse physically leave a client. Stay with yourclient to provide support and comfort. The best response for this question is B.

Essential NCLEX-PN Knowledge Certain conditions may have more complex issues. So, there will be more representation of them on the test. As you

prepare for the NCLEX, take note of the list of topics. It is much easier to use what you know when you have theappropriate knowledge going into the test.

Understand and differentiate normal laboratory values (serum sodium, potassium, calcium, creatinine,magnesium, BUN, phosphorus, WBCs, platelets, ESR, Hct, Hgb, pH, PaCO

2, SaO

2)

Differentiate normal laboratory values to clinically significant client care issues vs. clinically insignificant orclinically impossible scenarios

Review drug categories

Normal 24-hr intake and urine output

Peritoneal dialysis Hemodialysis

Complications (acute and chronic) of spinal cord transection: autonomic dysreflexia

Complications of hepatic failure: hepatic encephalopathy

Pregnancy-induced hypertension

Premature rupture of membranes: clinical management

Late decelerations: management

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NCLEX-PN TIPS 18


Oxytocin (Pitocin) administration

Sepsis: newborn and adult

Meningitis

Increased intracranial pressure: clinical manifestations

All types of traction

Compartment syndrome

Pulmonary embolus

Fat embolus

Hemophilia (A)

Sickle-cell crisis

Gastric bypass: dumping syndrome

Diets: diabetic, healthy heart, high fiber, renal, celiac, and regional enteritis

Emergency burn care

Procedures: nursing care (look for complications)

Growth and development

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NCLEX-PN TIPS 19

Overview

You know about the construction of the NCLEX exam, its administration, and general preparation techniques.You also know how to answer what is being asked and strategies for answering items when you have little orno knowledge about a topic. Now lets focus on getting the most difficult questions correct. These questionsare known as priority items. These items will ask you to recognize life and death issues and execute the nursingprocess in a fashion that provides clients with the highest level of safe and effective care.

Priority items dont have a label on the test. And, there is no set coding of how these items appear on the test.Instead, you must learn to identify how these items are written. Lets discuss some of the textual formatting thatwill help you recognize a priority item.

The table below lists statements commonly found in priority items. Note that many of them are asking you torecognize issues of life and death, and to make decisions that will keep clients safe.

Statements commonly found in priority items

Who should the nurse see first?

Which phone call should the nurse return first?

Who should the nurse transfer first?

Who should the nurse discharge first?

Which option requires an immediate intervention?

Which option requires no intervention?

Which nursing action is most important?

Which client should an LPN care for?

Which client should a float nurse care for?

Which assessment pattern is unexpected for this client?

Which assessment pattern is expected for this client?

Examine Question Layers

You may think that life and death issues are very easy to recognize in the text of a question. Unfortunately, theyare not always obvious. Instead, they are under words that, at first glance, seem to bear no clinical significance.To prevent glancing over these words and missing the most critical or impending symptom, you will need to askyourself: What could be the possible clinical significance of each answer choice? Lets look at a few items togetherand practice this strategy.

UNIT 5 MASTERING DIFFICULT QUESTIONS

Sections Examine Question Layers, Airway, Breathing, and Circulation (ABC), Safe and Effective Delegation

Mastering Difficult Questions

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NCLEX-PN TIPS 20

MASTERING DIFFICULT QUESTIONS

A nurse is caring for a client who has a cervical radium implant. Which of the following requires an immediate intervention bythe nurse?

A. The client is performing her own perineal care.

B. A staff member flushes the clients urine down the toilet.

C. A staff member removes dirty linens from the clients room.

D. The client is asking that visitors be restricted to immediate family.

The first option doesnt require immediate attention because the client has already been exposed to the sealedradium implant. The client is able to perform her own perineal care. Health care providers should never be close

enough to do perineal care for a client who has a radium implant due to the risk of exposure.

If you arent careful, you could easily glance over it. To answer the question correctly, you need to consciously askyourself, What is the potential safety risk of removing linen from this clients room? In other words, you need tolook beneath the words to find what may be a life and death issue.

If the radium implant displaces from the cervix into the bed linens and circulates within the central laundry supply,everyone may be at risk for exposure. On the surface, the second option seems to contain a life and death layer, butin reality, it is not an issue at all. Radium implants are sealed. So, theres no contamination to the urine. Flushingthe urine down the toilet is safe and doesnt require immediate attention. The fourth option is similar to the first inthat exposure to the radium implant is minimal for all people in the clients immediate surroundings. This measureprovides safety and doesnt require immediate attention. Therefore, C is correct. Never remove the bed linens untilyou remove the radium implant from the client.

A nurse is caring for an adolescent who was admitted after an automobile crash. Which of the following should the nurse

consider as a priority assessment finding?

A. Unilateral pelvic bruising

B. Capillary refill 3 seconds

C. Hypoactive bowel sounds

D. Elevated blood pressure

The first option describes a condition that may be very serious. As you consider your options, remember to askyourself, What is the clinical significance of the pelvic bruising? If the trauma to the pelvis was significant enoughto cause bruising, it may have been significant enough to cause a pelvic fracture or bleeding in the abdominal cavityTherefore, A is correct. Abdominal bruising is an external finding indicating potential internal injury. The nurseshould assess for complications of pelvic and/or abdominal trauma.

In the second option, the capillary refill is normal. So, you shouldnt investigate it first.

In the third option the clients bowel sounds are hypoactive. On the surface, this finding may seem clinicallysignificant. But you should expect this since the client has undergone physiologic and psychologic stress. Dontinvestigate this first.

In the last option, the blood pressure is slightly elevated, which may seem clinically significant. But, dontinvestigate it first. A client admitted to the hospital following a car crash will likely be anxious and in pain. So, youshould expect slight elevations in blood pressure and respiratory rate.

Airway, Breathing, and Circulation (ABC)

Priority items commonly address issues central to survival, specifically airway, breathing, and circulation (ABC).They ask you to recognize and intervene to preserve the respiratory and cardiovascular systems. Failure to protectthese systems will lead to client deterioration and death.

As you answer priority items, you should consider each answer as it relates to protection of a clients ABC. It is alsoimportant to consider ABC checks with the perspective of trying to save a clients life.

To avoid some common pitfalls when answering priority questions, be aware of the following:

It is not unusual to want to care for a client who, in your mind, is the sickest. However, this may be aninappropriate choice in triage situations. Clients who are so sick that you cant save them shouldnt receivetreatment first.

Many times you may feel empathy for innocent victims of injury and want to console them and check themquickly before moving on to learned strategies. An example of this might be a rape victim or a child whois a victim of neglect. Psychological issues are always secondary and never take priority over facilitation ofphysiologic safety.

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NCLEX-PN TIPS 22

MASTERING DIFFICULT QUESTIONS

Lets take a look at the following question:

A charge nurse is making assignments for three RNs and one licensedpractical nurse (LPN). The charge nurse plans to assign theLPN to the client who

A. is scheduled for a routine colonoscopy this afternoon.

B. is in balanced skeletal traction and had surgery 2 days ago.

C. has type 1 diabetes mellitus and is scheduled for discharge today.

D. has thick secretions from a tracheostomy that was performed yesterday.

The client in the first option is having a diagnostic test and therefore, requires teaching. An LPN cannot legally carefor this client.

The second option describes a client in traction, which is within the scope of LPN practice guidelines if the RNverifies competency.

The third option includes a teaching requirement, and the LPN cannot legally teach.

Normally, a LPN could care for the client in the fourth option. However, in this case, there is a possible life anddeath issue. The word thick implies that the client has a possible fluid-volume deficit. So, an RN needs to dealwith the ineffective airway clearance from the tenacious secretions so that the client can breathe more easily.

The correct answer is B. The LPN can care for the client who is in traction after the RN verifies the LPNs competencyin the task.

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NCLEX-PN TIPS 23

The very simple and straightforward strategies that youve learned in this module can help you:

Answer the question being asked by eliminating information that is irrelevant.

Use what you know in situations where you doubt your understanding of the topic.

Get the most difficult questions correct through identification of priority situations and life and death issues.

Understanding these strategies is a great beginning, but dont stop here. As you prepare for the NCLEX-PN, use thesestrategies on practice tests and refer to this module often to reinforce what youve learned. The more you practice,the sooner these strategies will become second nature to you. By the time you take the exam, your approach tothe test items will be systematic and objective. Remember, wherever you work or whatever position you hold, thenursing profession is wonderfully challenging and rewarding. Your future begins now. You may begin.

CONCLUSION

Conclusion

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CONCLUSION

BIBLIOGRAPHY

Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D.R. (1956). Taxonomy of educational objectives: The classification of educational goals. Handbook I. Cognitive Domain.New York: David McKay.

Ignatavicius, D. D. & Workman, M. L. (2010).Medical-surgical nursing: Critical thinking for collaborative care(6th ed.). Philadelphia: W.B. Saunders Co.

Lehne, R. A. (2010).Pharmacology for nursing care.(7th ed.). St. Louis: W.B. Saunders Co.

Lowdermilk, D. L., & Perry, S. E. (2007).Maternity and womens health Care (9th ed.). St. Louis, MO: Mosby.National Council of State Boards of Nursing. (2011). National Council of State Boards of Nursing detailed test plan for the NCLEX-PN examination. Retrieved September 6, 2011, from www.ncsbn.org/index.htm.

Potter, P. A., & Perry, A. G. (2009).Fundamentals of nursing(7th ed.). St. Louis, MO: Mosby.

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